Funding of Care and Support

Lord Sutherland of Houndwood Excerpts

Thursday 24th November 2011 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for introducing this debate in such a comprehensive, clear and incisive manner. I thank her, too, for the reference to the usual suspects. I am happy and proud to join her as one of them. Looking around the Chamber, most of us have form in this area. Remember “Butch Cassidy and the Sundance Kid”? In the film, as they are pursued by the Pinkerton men, Butch and Sundance look back and Butch, seeing the cloud on the horizon, says, “Who are these guys?”. We are these guys. We will not give up. We will continue the pursuit because this is such a critical matter. I thank Paul Newman and company for that. I shall group my remarks under a heading borrowed from Al Gore's influential book An Inconvenient Truth. I may use other catchphrases, some of which are stolen from MBA speak, such as “the elephant in the room”, but I want our minds to focus on “inconvenient truth”.

Today we address the Dilnot report, a good report, as one would expect from that stable. I have no hesitation in giving it my very warm support. Contrary to basic belief, we did not profligately recommend the free expenditure of money; we recommended a form of co-payment. I accept that the co-payment line has to be different today, and that is why I find it easy to support what Dilnot proposed. We address the report, but we do not address a government response. That is interesting and important. We have been here before—a situation where apparently the Government take longer to read the report than the excellent team took to write it. From past experience, this is not a good sign.

Occasional possible sightings of Dilnot have been reported, but they are usually accompanied by a pursing of Treasury lips and mutters about the state of the euro and that spendthrift bunch who were in government before. But of the report, there has not been a clear, authenticated sighting. Perhaps we should put David Attenborough on to it. It is perhaps in some frozen grotto in the north awaiting revival.

However, my simple thesis is this: the Dilnot report represents an inconvenient truth—none the less true for being inconvenient. The problems to which it points and the reasons for which it was commissioned—yes, it was commissioned, to the credit of the current coalition Government—have not gone away. It is not that the report has not gone away, but that the issues have not gone away, which is why some of us are here again. They will not go away. They will become more and more pressing the longer we ignore them.

What are the reasons for the delay in the Government’s response? They are the usual ones: “We need more time and information” or “We are consulting”. One thing successive Governments are not short of is advice. There is no need for further consultation. Think of the range of reports I could drop before the House today—I thought about bringing them in, but I would get back strain lifting them: the Joseph Rowntree Foundation report; the Wanless report from the King’s Fund; a report from the LSE by Raphael Wittenberg and colleagues; the 2006 report from the Audit Commission, the Healthcare Commission and CSCI; Her Majesty's Government’s 2006 report Opportunity Age; and their 2009 Green Paper Shaping the Future of Care Together. There was also an IPPR report; I could go on. The Law Commission has already been mentioned. There is plenty of advice. It is decisions that are needed. We need a policy.

All of those reports presented inconvenient truths to successive Governments. We have 13 years of history of this. For example, a government report in 2005 pointed out that by 2051 over 25 per cent of the population will be over 65. Wanless pointed out that the cost of care of older people will rise from £3.7 billion to £8 billion with the net cost to government rising to £1.7 billion. Wittenberg has equivalently devastating statistics. We all know them. I look around the House. Noble Lords know these statistics, and I do not need to repeat them. There is a constant litany on demographic change in this and in other countries. My favourite statistic is that in the course of this debate, if we all keep to time, noble Lords’ statistical life expectancy will rise by 30 minutes. That is not a cashable cheque, but statistically that is the rate of demographic change. These are facts. They are true, but they are inconvenient.

There is a litany of further inconvenient truths: our systems for coping with demographic change are getting worse rather than better. We should note the report that was published yesterday, of which mention has been made, about the failings of care at home; the continuing drip, drip of stories about the failings of residential care and care of the elderly in hospital; and the way in which money allocated to local authorities for these purposes, because it not being ring-fenced, is not visible at point of delivery.

I had a letter last week from someone who runs care homes, which, as far as I can see, are run very well. She reports that the price local authorities are willing to pay is £200 per week under the real price. The homes deal with it, not by cutting staff, which is the inevitable route taken by many, but by raising the money elsewhere. I say, good for them, but not everyone has that capacity. The drip, drip, drip, the points to note and the failures of the system are inevitably reported to us. They are the inconvenient truths.

A further inconvenient truth is an unplanned, unco-ordinated and inadequate system, which is approaching the point of breakdown. Ministers should beware because they will be to blame. MPs should beware because older people vote and will hit them in the ballot box, which is the only place that they have left. Governments may contrive to ignore this but they cannot. These inconvenient truths will not go away.

There are convenient ways in which the Government operate which set these aside. I shall list them. Do not upset the Treasury applecart—it has a system for limiting expenditure and no exceptions are allowed. Do not tamper with the historic power of departments—their budgets should be subject to only marginal change. Especially, do not tamper with the fortifications which separate the budgets for healthcare and social care. We do not recognise the elephant in the room. I put it to the Government that it is time now to recognise it and to deal with these inconvenient truths.